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Pregnancy Outcomes after Treatment for Cervical Cancer Precursor Lesions: An Observational Study

OBJECTIVE: To examine whether surgical procedures involving the uterine cervix were associated with pregnancy outcomes, including preterm birth, low birth weight, cesarean delivery and pregnancy loss. DESIGN: Population-based observational study nested in retrospective matched cohort SETTING: Kaiser...

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Autores principales: Weinmann, Sheila, Naleway, Allison, Swamy, Geeta, Krishnarajah, Girishanthy, Arondekar, Bhakti, Fernandez, Jovelle, Myers, Evan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5214346/
https://www.ncbi.nlm.nih.gov/pubmed/28052083
http://dx.doi.org/10.1371/journal.pone.0165276
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author Weinmann, Sheila
Naleway, Allison
Swamy, Geeta
Krishnarajah, Girishanthy
Arondekar, Bhakti
Fernandez, Jovelle
Myers, Evan
author_facet Weinmann, Sheila
Naleway, Allison
Swamy, Geeta
Krishnarajah, Girishanthy
Arondekar, Bhakti
Fernandez, Jovelle
Myers, Evan
author_sort Weinmann, Sheila
collection PubMed
description OBJECTIVE: To examine whether surgical procedures involving the uterine cervix were associated with pregnancy outcomes, including preterm birth, low birth weight, cesarean delivery and pregnancy loss. DESIGN: Population-based observational study nested in retrospective matched cohort SETTING: Kaiser Permanente Northwest integrated health plan in Oregon/Washington, U.S.A. POPULATION: Female health plan members age 14–53 years with documented pregnancies from 1998–2009. Women with prior excisional and ablative cervical surgical procedures (N = 322) were compared to women unexposed to cervical procedures (N = 4,307) and, separately, to those having undergone only diagnostic/biopsy procedures (N = 847). METHODS: Using log-linear regression models, we examined risk of adverse pregnancy outcomes in relation to prior excisional or ablative cervical surgical procedures. We stratified excisional procedures by excision thickness. We evaluated for confounding by age, body mass index, race, smoking history, previous preterm birth, and parity. RESULTS: We found a positive association between excisional treatment > = 1.0 cm and the outcomes preterm birth and low birth weight (preterm birth unadjusted risk ratio [RR] = 2.15, 95% confidence interval [CI] 1.16–3.98 for excisions ≥1.0 cm compared to unexposed women), particularly in women who delivered within one year of surgery (RR = 3.26, 95% CI 1.41–7.53). There was no clear association between excisional treatment and cesarean delivery, and treated women did not have a substantially higher risk of dysfunctional labor. Ablative treatment was not associated with low birth weight, preterm birth, or cesarean delivery but was associated with pregnancy loss (RR = 1.43, 95% CI 1.05–1.93 vs. unexposed women). Analyses using the diagnostic procedures comparison group produced similar results. CONCLUSION: Women with > = 1.0 cm excisional treatment had elevated risk of preterm birth and low birth weight when compared to unexposed women and women with cervical diagnostic procedures. This suggests that increased risk derives from the treatment itself, not from other characteristics. The observed association between pregnancy loss and ablative surgical treatment requires further investigation.
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spelling pubmed-52143462017-01-19 Pregnancy Outcomes after Treatment for Cervical Cancer Precursor Lesions: An Observational Study Weinmann, Sheila Naleway, Allison Swamy, Geeta Krishnarajah, Girishanthy Arondekar, Bhakti Fernandez, Jovelle Myers, Evan PLoS One Research Article OBJECTIVE: To examine whether surgical procedures involving the uterine cervix were associated with pregnancy outcomes, including preterm birth, low birth weight, cesarean delivery and pregnancy loss. DESIGN: Population-based observational study nested in retrospective matched cohort SETTING: Kaiser Permanente Northwest integrated health plan in Oregon/Washington, U.S.A. POPULATION: Female health plan members age 14–53 years with documented pregnancies from 1998–2009. Women with prior excisional and ablative cervical surgical procedures (N = 322) were compared to women unexposed to cervical procedures (N = 4,307) and, separately, to those having undergone only diagnostic/biopsy procedures (N = 847). METHODS: Using log-linear regression models, we examined risk of adverse pregnancy outcomes in relation to prior excisional or ablative cervical surgical procedures. We stratified excisional procedures by excision thickness. We evaluated for confounding by age, body mass index, race, smoking history, previous preterm birth, and parity. RESULTS: We found a positive association between excisional treatment > = 1.0 cm and the outcomes preterm birth and low birth weight (preterm birth unadjusted risk ratio [RR] = 2.15, 95% confidence interval [CI] 1.16–3.98 for excisions ≥1.0 cm compared to unexposed women), particularly in women who delivered within one year of surgery (RR = 3.26, 95% CI 1.41–7.53). There was no clear association between excisional treatment and cesarean delivery, and treated women did not have a substantially higher risk of dysfunctional labor. Ablative treatment was not associated with low birth weight, preterm birth, or cesarean delivery but was associated with pregnancy loss (RR = 1.43, 95% CI 1.05–1.93 vs. unexposed women). Analyses using the diagnostic procedures comparison group produced similar results. CONCLUSION: Women with > = 1.0 cm excisional treatment had elevated risk of preterm birth and low birth weight when compared to unexposed women and women with cervical diagnostic procedures. This suggests that increased risk derives from the treatment itself, not from other characteristics. The observed association between pregnancy loss and ablative surgical treatment requires further investigation. Public Library of Science 2017-01-04 /pmc/articles/PMC5214346/ /pubmed/28052083 http://dx.doi.org/10.1371/journal.pone.0165276 Text en © 2017 Weinmann et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Weinmann, Sheila
Naleway, Allison
Swamy, Geeta
Krishnarajah, Girishanthy
Arondekar, Bhakti
Fernandez, Jovelle
Myers, Evan
Pregnancy Outcomes after Treatment for Cervical Cancer Precursor Lesions: An Observational Study
title Pregnancy Outcomes after Treatment for Cervical Cancer Precursor Lesions: An Observational Study
title_full Pregnancy Outcomes after Treatment for Cervical Cancer Precursor Lesions: An Observational Study
title_fullStr Pregnancy Outcomes after Treatment for Cervical Cancer Precursor Lesions: An Observational Study
title_full_unstemmed Pregnancy Outcomes after Treatment for Cervical Cancer Precursor Lesions: An Observational Study
title_short Pregnancy Outcomes after Treatment for Cervical Cancer Precursor Lesions: An Observational Study
title_sort pregnancy outcomes after treatment for cervical cancer precursor lesions: an observational study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5214346/
https://www.ncbi.nlm.nih.gov/pubmed/28052083
http://dx.doi.org/10.1371/journal.pone.0165276
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